Healthcare Provider Details

I. General information

NPI: 1528338449
Provider Name (Legal Business Name): DOMINICK SALVATORE ZITO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AVIATION PLZ
JAMAICA NY
11434-4809
US

IV. Provider business mailing address

2112 MAPLE ST
WANTAGH NY
11793-4108
US

V. Phone/Fax

Practice location:
  • Phone: 718-553-3300
  • Fax:
Mailing address:
  • Phone: 516-221-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number170558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: